by Robert J. Lanz, LCSW
I live in a neighborhood called Silver Lake, deemed by Forbes magazine to be the hippest neighborhood in the USA. I’m third generation living in the cool Silver Lake bungalow that my grandparents built in 1928. Many of my neighbors are in show business one way or another: writers, actors, sound men, even a guy across the street who specializes in zombie makeup. There are Grammy winners, famous actors from TV and the big screen who live like normal folks here. Many of them asked me about this new show, The Night Shift, about life in the ER.
I watched a couple of episodes before I turned it off forever. It is the worst depiction of ER life I have ever seen. It is more like a video game than a show. It should be a soap opera not a evening TV show.
The characters all have unbelievable back-stories.
They are all cliched.
They apparently don’t have a medical consultant, as the medical care is laughable. They apparently don’t have a medical ethicist either. Every time they get to the crossroads of a moral dilemma, they take the wrong turn
In case nobody told them, you can’t cross-match and do heart surgery with ER docs in the O.R. If an ER doc went to the O.R. he’d be laughed out of the room. Oh, writers for this series here’s a clue: resuscitated people usually stay on a ventilator for a while and have IV’s and stuff. People that sick, look, well, that sick. There is no social worker on the team, I guess that’s a blessing as whatever stereotype of us exists would be through the roof. But they do have a full-time psychiatrist, ON THE NIGHT SHIFT! It was rare to ever see a psychiatrist in the ER let alone have one live there. Oh yeah. If we did have one I doubt she’d be boinking the narcissistic ER doc in the store room.
I could go on and on but won’t. Check it out for yourself.
Interestingly, my copyrighted book about life in the ER is also called The Night Shift. If I hadn’t been sick for a year it would been in print by now. It will be soon. Maybe I should add a subtitle: Life in the ER: more than the effing soap opera portrayed on NBC.
Jones was probably a jerk before he crashed his motorcycle while high on drugs and got some brain damage. I don’t recall ever reading about a person whose personality was improved by brain damage, and that includes all kinds of brain damage from things like big head whacks, strokes and even Alzheimer’s. The exception to this rule may be those poor psychotics who had lobotomies before there was medicine that pretty much could have achieved the same purpose, the dulling of an overactive, crazy mind.
Jones wasn’t one to go outside the box. He was apparently well-known to the cops and paramedics long before he did his face plant in the street and became “disabled”. There was enough left of his broken brain for him to realize that now he was more than your average jerk, he was a disabled jerk. And he didn’t like that life any more than his previous, non-disabled one. Being an jerk, he lacked insight and wisdom and took out his frustration on anyone in his striking zone.
He became one of the ER “regulars” but not in any good sense. Unlike most of our regulars, he was totally without any redeeming qualities. He always showed disrespect and never apologized for his transgressions. I guess that’s why everyone thought he was such an idiot. He was relentless. Most of us have a great deal of tolerance or we couldn’t last long in the ER, but Jones was forever pushing the boundaries. It seemed like he was always having a bad night. When a guy always has a bad night, sooner or later he will bump up against one of us who may also be having a bad night, and he will become the proverbial “last straw”. That’s what happened the night I thought I killed him. Not deliberately, but had he died, I would have had some serious explaining to do.
People come to the ER for a lot of reasons, many of them having nothing to do with any medical condition, at least not any acute medical condition. Many people with chronic medical conditions take advantage of the 24/7 deal we offer in the ER. We see anyone, any time for any reason. If the reason turns out to be bogus, the doctor will punt to the social worker and ask that we disposition this patient. It’s pretty much up to us to figure out what to do with a person who has no medical treatment issues that would match up with what we do in the ER. That’s a social work issue: A patient with no medical problem looking for help in a medical environment. Jones was on the list that night.
He had come in with the vaguest of complaints—belly pain—demanding Demerol. At the end of these kinds of workups, the physician often makes the case that the abdominal pain comes from the patient being full of crap. To get to that point in the diagnosis may take several hours, multiple tests and maybe even some radiological studies. That would give a guy like Jones plenty of time to piss a lot of people off. He would piss off the triage nurse as soon as he hit the door. He would piss off the phlebotomist when she drew his blood. He would piss off the X-ray tech just for the hell of it, and then he would piss off the doctor who had more or less told him his problem was that he was just full of crap.
Jones didn’t appreciate it when things like that happened. He had come to the ER with a plan, and it appears that the plan was to complain of enough pain to be admitted and get a nice warm bed, perhaps a hot nurse and some great pain medicine in his veins. This was a common dream among certain ER visitors and to have a dream so blatantly busted is too much for some folks. That’s especially true for jerks with brain damage. There’s just no talking to them.
Of course, he didn’t want to leave the ER, and he didn’t want to accept that he wasn’t sick enough to take up bed space upstairs. He was about to go through as long a list of tirades as necessary to be able to live his dream. Instead, after a bad night with many actual sick patients, he found himself in a nightmare. He got me, and I wasn’t in a much better mood than he was. The perversity of too little time and too many patients led me to believe that I would feel better if he felt worse.
“Bob, I’m not leaving tonight. I’m too sick. I can’t go home.”
“Well, we’re through with you here tonight. The doctor doesn’t think you need to be admitted so you’ll have to leave. Any questions?”
“I’m too sick to go home.”
“That’s a problem because no one here is going to admit you.”
“I can’t go home. I can’t control my bowels.”
“Well, you’ve been here for several hours and you controlled your bowels okay. I read the nurses notes and spoke to your doctor.”
“I can’t control my bowels. Watch.”
Maybe if he hadn’t been wearing short pants, the feces splattering down his leg wouldn’t have had such an effect on me. Maybe if I wasn’t so wound up myself I could have let it go. But that’s too many maybes for the mood I was in, and the ER felt like the OK Corral right at that moment.
Jones and I were next to the nurses’ station, and about fifteen people were watching us. We were also very close to the Hazardous Materials shower, and it seemed obvious to me that Jones was highly hazardous and needed to be hosed down. I grabbed him, put him into a wheelchair and rolled him in. No need to take off his clothes. After his controlled poop, there was no way I was handing out fresh ones to this guy. Unfortunately for Jones, I hadn’t been at work the day they changed the Hazardous Materials shower to a high-powered Hazardous Materials shower.
Jones was chair-slumped in the shower when I pulled that big overhead ring that starts the rush of water. I thought that a little flush would make him less hazardous. But what he got was all fifty gallons at once, the flush of all flushes, and the power of it pushed—actually more like propelled, his body out of the chair at such speed that he hit the tile wall with enough force that, for a moment, I thought he was dead. He didn’t move and neither did anyone else.
Then he started to scream at the top of his lungs.
“All right! All right! I give up. I’ll leave! Get me out of here!”
I quickly offered him some dry clothes, but he declined and left in a hurry. Everyone in the ER thought it was pretty funny. I guess they didn’t see my face for that few seconds it took for him to start moving after hitting the shower wall. It almost scared the crap out of me, too. A true amygdala hijack
That was a lesson learned. The next time Jones comes in on a bad night and shits down his leg on purpose, I’ll let someone else handle his disposition.